HomeMy WebLinkAboutWELL-09-2022-181445.TIF . CATAWBA COUNTY ;, h
� a Case# WELL-09-2022-181445
PublicU Health Department) r Subdivision AARON H LAIL
d '3 Environmental Health Division PIN# 460703144409
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PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 7 •
Site Address: 3868 LANDMARK DR, SHERRILLS FORD NC 28673
Name on Permit: JONATHAN HART
Property Size: Acres 0.49
Directions: Hwy 150 to Little Mt Rd, Little Mt Rd,to Landmark Dr, Property on Lakeside
Owner/Authorized Representative Acknowledgement of Permit Receipt
K _I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of . .the property described above. i
_ As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2021-37020,by the following method(s):
Received in Person •
Facsimile Transmittal(Return form with signature required)
TElectronic Image Transmittal/E-mail (Return receipt required)
•
As the property owner or authorized representative I have reviewed and understand the specific conditions
of the permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.1900), •'.;,
- and/or Well Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date:09/30/2022
Owner/Authorized Representative Signature
Date
1 i ►'I 6hAnclQ1 ne
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
BSignature C Date/Time 1O'd7)
Method: Fax I Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpenuit 09/30/2022 09:30